Abstracts

Rationale: Research demonstrates that up to 30 % of patients referred to Epilepsy Centers for refractory seizures have psychogenic non-epileptic seizures (PNES). Patients are often left feeling stigmatized and many times question the validity of the psychological nature of their seizures. Because patients with PNES frequently fail to accept the diagnosis, they also fail to follow through with the recommended mental health treatment with subsequent poor outcomes. (Alsadi & Marquez, 2005; LaFrance, 2008) Several studies have supported the need for psychological support at the time of diagnostic disclosure. (Shen et al, 1990; Benbadis, 2005) Advanced practice psychiatric nurses can provide that support. This pilot study was designed to determine if support and education that go beyond standard care might impact the patient's acceptance of the diagnosis and improve compliance with recommended mental health services.Methods: Nineteen subjects, aged 18-66 years, admitted to an Epilepsy Monitoring Unit (EMU) were randomly assigned to a Control or Treatment group after they completed the consent form. The control group received standard care in which the neurologist informs the patient of the diagnosis and recommends seeking mental health care. The treatment group received the additional educational support by an advanced practice psychiatric nurse. The 40-90 minute intervention used reframing to help the patient view the diagnosis with a more positive perspective. The reframing approach included: identification of the subject's strengths, assesssment of the subject's point of view about the PNES diagnosis, addressing feelings of shame or stigma if they arose during the interview, discussing the contributions of their individual life stressors and finally encouraging the acceptance of psychologcal services after discharge. At the 5 week post-discharge time, the PI sent a letter to all 19 subjects to remind them of the follow-up phone interview. This phone interview was conducted by another of the co-authors between 6-8 weeks after discharge from the EMU.Results: The primary outcome proved to be significantly impacted (p=.003) by the intervention. All of the subjects (9) in the treatment group did make/keep an appointment with a psychotherapist or psychiatrist within 6-8 weeks of discharge from the EMU. Only 5 (50%) of the 10 in the control group reported making or keeping an appointment when called. Two subjects in the control group expressed disbelief in the PNES diagnosis. None of the subjects in the treatment group expressed disbelief in the diagnosis. Secondary outcome measure included changes in the seizure frequency and/or intensity. There was not a significant decrease in either group.Conclusions: This positive reframing educational intervention proved to help the treatment group to better accept the diagnosis and subsequently commit to a psychological treatment approach after they were given the PNES diagnosis.